PDF(Pubmed)
Abstract：
UNASSIGNED: Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated.
UNASSIGNED: To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice.
UNASSIGNED: This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study.
UNASSIGNED: A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template.
UNASSIGNED: The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures.
UNASSIGNED: The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]).
UNASSIGNED: The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT06284148.
UNASSIGNED: To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice.
UNASSIGNED: This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study.
UNASSIGNED: A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template.
UNASSIGNED: The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures.
UNASSIGNED: The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]).
UNASSIGNED: The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT06284148.
摘要：
亲密伴侣暴力（IPV）是一个重大的公共卫生问题，终生患病率为25%。在初级保健中筛查IPV是一种推荐的做法，其有效性存在争议。
■评估基于电子健康记录（EHR）的多因素干预筛查对初级保健实践中IPV风险检测的影响。
■这项整群随机临床试验使用阶梯式楔形设计，从2020年10月6日至2023年3月31日，将查尔斯顿地区南卡罗来纳医科大学卫生系统的15个家庭医学初级保健诊所分配到3个匹配的区块。在这些诊所就诊的所有18至49岁的女性都参与了这项研究。
■使用EHR平台，通过计算机问卷调查进行不间断的EHR警报，然后进行风险评估和决策支持模板。
■主要结果是患者在诊所进行IPV筛查的比率，以及通过筛查程序检测到有IPV风险的患者的比率。
■研究诊所照顾了8895名独特患者(平均[SD]年龄，34.6[8.7]年；1270[14.3%]医疗补助或医疗保险，7625[85.7%]私人，军事,或其他保险)在符合筛查干预条件的研究期内。干预对IPV的总体筛查率有显著影响，当不间断警报处于活动状态（相对风险，1.46[95%CI，1.44-1.49]；P<.001）。在识别报告过去一年IPV的患者时，机密筛查过程比基线护士主导的口腔筛查更有效（8895例患者中的130例[1.5％]对17433例患者中的9例[0.1％]）。
■干预措施在增加初级保健中的筛查依从性和IPV阳性检出率方面在很大程度上是有效的。在初级保健中筛查IPV的高度私密方法可能是必要的，以实现足够的检出率，同时解决经历IPV的患者的潜在安全问题。
■ClinicalTrials.gov标识符：NCT06284148。
■评估基于电子健康记录（EHR）的多因素干预筛查对初级保健实践中IPV风险检测的影响。
■这项整群随机临床试验使用阶梯式楔形设计，从2020年10月6日至2023年3月31日，将查尔斯顿地区南卡罗来纳医科大学卫生系统的15个家庭医学初级保健诊所分配到3个匹配的区块。在这些诊所就诊的所有18至49岁的女性都参与了这项研究。
■使用EHR平台，通过计算机问卷调查进行不间断的EHR警报，然后进行风险评估和决策支持模板。
■主要结果是患者在诊所进行IPV筛查的比率，以及通过筛查程序检测到有IPV风险的患者的比率。
■研究诊所照顾了8895名独特患者(平均[SD]年龄，34.6[8.7]年；1270[14.3%]医疗补助或医疗保险，7625[85.7%]私人，军事,或其他保险)在符合筛查干预条件的研究期内。干预对IPV的总体筛查率有显著影响，当不间断警报处于活动状态（相对风险，1.46[95%CI，1.44-1.49]；P<.001）。在识别报告过去一年IPV的患者时，机密筛查过程比基线护士主导的口腔筛查更有效（8895例患者中的130例[1.5％]对17433例患者中的9例[0.1％]）。
■干预措施在增加初级保健中的筛查依从性和IPV阳性检出率方面在很大程度上是有效的。在初级保健中筛查IPV的高度私密方法可能是必要的，以实现足够的检出率，同时解决经历IPV的患者的潜在安全问题。
■ClinicalTrials.gov标识符：NCT06284148。
